Suturing system

ABSTRACT

A suturing system including apparatus and methods for disposing stitches in a substrate comprising a thread carrier which inserts a thread in the substrate at a first location and withdraws the thread from the substrate at a second location.

This United States Patent Application is a continuation of U.S. patentapplication Ser. No. 15/947,612, filed Apr. 6, 2018, hereby incorporatedby reference herein.

I. BACKGROUND

A suturing system including apparatus and methods for disposing stitchesin a substrate comprising a thread carrier which inserts a thread in thesubstrate at a first location and withdraws the thread from thesubstrate at a second location.

II. SUMMARY OF THE INVENTION

Accordingly, a broad object of the present invention is to provide anapparatus including one or more of a suturing probe including a threadcapture chamber disposed adjacent a substrate capture chamber having achamber port open to a suturing probe external surface and a threadcarrier slidingly engaged to the suturing probe which passes outside ofthe substrate capture chamber into the thread capture chamber.

Another broad object of the present invention is to provide a method formaking an apparatus including one or more of disposing in a suturingprobe a thread capture chamber adjacent a substrate capture chamberhaving a chamber port opening to a suturing probe external surface andslidingly engaging a thread carrier in the suturing probe, the threadcarrier passing outside of the substrate capture chamber into the threadcapture chamber.

Another broad object of the present invention is to provide a method ofusing an apparatus including one or more of capturing a substrate in asubstrate capturing chamber of a suturing probe and driving a threadcarrier in the suturing probe toward a thread capture chamber adjacentto the substrate capture chamber, the thread carrier passing through thesubstrate into the thread capture chamber outside the substrate capturechamber.

Naturally, further objects of the invention are disclosed throughoutother areas of the specification, drawings, photographs, and claims.

III. A BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a first perspective view of an embodiment of the suturingapparatus having a thread carrier in a retracted condition.

FIG. 2 is a second perspective view of an embodiment of the suturingapparatus having the thread carrier in an extended condition.

FIG. 3 is a first side elevation view of an embodiment of the suturingapparatus.

FIG. 4 is a top plan view of an embodiment of the suturing apparatus.

FIG. 5 is a second side elevation view of an embodiment of the suturingapparatus.

FIG. 6 is a bottom plan view of an embodiment of the suturing apparatus.

FIG. 7 is an enlarged view of the suturing probe shown in FIG. 1.

FIG. 8 is an enlarged view of the suturing probe shown FIG. 2.

FIG. 9 is an enlarged view of the portion 9 shown in FIG. 3 sideelevation view of a particular embodiment of a suturing probe.

FIG. 10 is an enlarged view of the suturing probe shown in FIG. 10.

FIG. 11 is a cross section view 11-11 as shown in FIG. 4 of a particularembodiment of a suturing probe and a substrate capture chamber insertremoved from a substrate capture chamber.

FIG. 12 is a cross section view 12-12 as shown in FIG. 4 of a particularembodiment of a suturing probe and a substrate capture chamber insertcoupled to a substrate capture chamber.

FIG. 13 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture chamber.

FIG. 14 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 15 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 16 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier extended into the thread capture assembly and engaged with thethread capture assembly.

FIG. 17 is a cross section view of a particular embodiment of a suturingapparatus as shown in FIG. 4.

FIG. 18 is an enlarged view of a portion of the cross section of aparticular embodiment of a suturing probe shown in FIG. 17.

FIG. 19 is an enlarged perspective view of a portion of the crosssection of a particular embodiment of a handle shown in FIG. 17.

FIG. 20 is an enlarged view of a cross section 20-20 of a particularembodiment of a tubular member shown in FIG. 4.

FIG. 21 is an enlarged cross section view of a particular embodiment ofan arrest assembly in a thread carrier first position.

FIG. 22 is an enlarged cross section view of a particular embodiment ofan arrest assembly between a thread carrier first position and a threadcarrier second position.

FIG. 23 is an enlarged cross section view of a particular embodiment ofan arrest assembly in a thread carrier second position.

FIG. 24 is a perspective view of a particular embodiment of a suturingapparatus having a thread passing through the thread carrier apertureand disposed in a thread catch.

FIG. 25 is an enlarged perspective view of a thread catch as shown inFIG. 1.

FIG. 26 is an enlarged perspective view of a thread catch as shown inFIG. 1.

FIG. 27 is an enlarged side view of a particular embodiment of a threadcatch.

FIG. 28 is an enlarged plan view of a particular embodiment of a threadcatch.

FIG. 29 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread carrier extended into the thread capturechamber.

FIG. 30 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread carrier engaged with the thread captureassembly.

FIG. 31 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having engaged with the thread capture assembly.

FIG. 32 is an enlarged view of a particular embodiment of a threadcarrier and a thread capture assembly showing the position of the threadcarrier having a thread captured by the thread capture assembly.

FIG. 33A is a depiction of a particular method of using a suturingapparatus.

FIG. 33B is a depiction of a particular method of inserting a suturingprobe in a body opening.

FIG. 33C is a depiction of a particular method of palpating a substratetoward a substrate capture chamber.

FIG. 33D is a depiction of a particular method of operating the suturingapparatus to drive the thread carrier through a substrate.

FIG. 33E is a depiction of a particular method of disposing suture loopthe substrate and removing a suturing probe from a body opening.

FIG. 34 is an illustration of a plurality of suture purchases obtainedby use of the suturing apparatus.

IV. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Generally referring to FIGS. 1 through 31, embodiments of a suturingapparatus (1) including a substrate capture chamber (2) and a threadcarrier (3) carrying a thread (4) which axially moves between aretracted condition (5) toward an extended condition (6) in which athread carrier terminal end (7) of the thread carrier (3) passes outsideof the substrate capture chamber (2) into a thread capture chamber (8)to engage a thread capture assembly (9) which captures the thread (4) togenerate a thread loop upon return of the thread carrier (3) toward theretracted condition (5).

Now referring primarily to FIGS. 1 through 10, embodiments of thesuturing apparatus (1) can include a suturing probe (10). The suturingprobe (10) can outward axially extend from a tubular member (11) toterminate in a probe tip (12). The suturing probe external surface (13)can, but need not necessarily, be configured as an extension of theexternal dimensions of the tubular member (11) allowing the probe tip(12) to pass through body openings (14) such as natural body openings orincisions to engage a substrate (15) (as shown in the illustrativeexample of FIGS. 33A through 33E) such as skin, fascia, fat, or muscle.While particular examples of a substrate (15) include tissue (16)including human or animal tissue, this description is not intended topreclude the capture of substrates (15) other than human or animaltissue, including as illustrative examples, cadaver tissue, simulants oftissue, tissue models, elastomer components, plastic or natural fabrics,or the like.

Again referring primarily to FIGS. 1 through 10, in particularembodiments, the suturing probe (10) can have a generally cylindricalsuturing probe external surface (13) terminating in a hebetated probetip (12). As to particular embodiments, the suturing probe externalsurface (13) can include a tapered, beveled, or sloped surfaceapproaching the probe tip (12) to reduce dimensions at the probe tip(12). There can be an advantage in having a sloped, tapered or inclinedprobe face (17) as it allows the suturing probe (10) additional ingressinto a substrate (15) such as animal tissues with a lesser amount oftissue dissection or trauma.

Again, referring primarily to FIGS. 1 through 10, in particularembodiments, a substrate capture chamber (2) can be disposed in thesuturing probe (10). The substrate capture chamber (2) can include achamber sidewall (18) which couples in opposed fixed relation a chamberbottom (19) a distance from said chamber port (20) open to the suturingprobe external surface (13). In particular embodiments, the verticalchamber side wall (18) can define a periphery of greater circumferencethan the periphery of the chamber port (20). In particular embodiments,the substrate capture chamber (2) can, but need not necessarily, befluidically coupled to a vacuum source (21) operable to generate areduced chamber pressure (22) in the substrate capture chamber (2)sufficient to capture, draw, or dispose a substrate (15) into thesubstrate capture chamber (2).

In particular embodiments, the suturing probe (10) can include arecessed portion (23) with the chamber port (20) open to the recessedportion (23) of the suturing probe external surface (13) with the threadcarrier (3) operable to pass within the recessed portion (23) of thesuturing probe external surface (13) outside of the substrate capturechamber (2). In particular embodiments, the recessed portion (23) of thesuturing probe external surface (13) can be arcuate (as shown in theillustrative examples of FIGS. 7 through 9). The arcuate recessedportion (23) of the suturing probe external surface (13) can, but neednot necessarily, be configured to allow a tip of a finger (24) to applyforce to a substrate (15) to move the substrate toward the substratecapture chamber (2) (as shown in the illustrative example of FIG. 33C).

Now referring primarily to FIGS. 7 through 10, the recessed portion (23)of the suturing probe external surface (13) can include a substantiallyflat arcuate face (25), The recessed portion 23 delimits an open areainto which the chamber port (20) opens. A recessed peripheral margin(26) circumscribes an entry of the open area delimited by the recessedportion 23. There can be an advantage in a recessed peripheral margin(26) which affords a substantially flat or lessened curvature about thechamber port (20) in that it can increase the surface area of thesuturing probe external surface (13) contacting a substrate (15). Theincreased surface area of the suturing probe external surface (13) canafford a substantial advantage in capture of a substrate (15) in thoseembodiments in which a reduced chamber pressure (22) can be generated inthe substrate capture chamber (2) or can decrease movement of thesuturing probe (10) in relation to substrate (15) captured in thesubstrate capture chamber (2). As can be seen in the drawings chamberport 20 comprises a transition edge which circumscribes an area lessthan the area circumscribed by peripheral margin 26.

Now referring primarily to FIGS. 1, 2, 4, and 10, the chamber port (20)can, but need not necessarily, be disposed in a stadium configuration(27), being a rectangle with semicircles at a pair of opposite sides.The substrate capture chamber (2) can, but need not necessarily, have achamber bottom (19) in a stadium configuration disposed opposite thechamber port (20) in stadium configuration connected by a substantiallyvertical chamber sidewall (18).

Referring to FIG. 34, there can be an advantage in a substrate capturechamber (2) of stadium configuration (27) in that an increased amount ofsubstrate (15) can be disposed in the substrate capture chamber ascompared to a substrate capture chamber having conventionally slotted orsubstantially circular substrate capture chamber (2) and correspondinglythe substrate (15) penetrated by the thread carrier (3) can dispose athread entry point (28) and a thread withdraw point (29) a greaterdistance apart (also referred to as the “suture purchase (30)) ascompared to conventional slotted or cylindrical suction chambers. Thesuture purchase (30) generated by use of a stadium configuration (27)can be substantially greater than that obtained using a suction chamberof cylindrical configuration or obtained using a conventional suctionchamber of slotted configuration. It may be that the conventionalcylindrical configuration draws the substrate into a conicalconfiguration within the conventional cylindrical suction chamber andthe conventional needle only penetrates the substrate proximate the apexof the cone. It may be that the conventional slotted suction chamberdoes not have sufficient volume to dispose the substrate a sufficientdistance into the conventional slotted chamber and the conventionalneedle only penetrates the substrate layers in adjacent relation closeto the fold or edges.

Now referring to FIGS. 11 and 12, particular embodiments of the suturingprobe can include a substrate capture chamber insert (31). The substratecapture chamber insert (31) can include a substrate capture chamberinsert sidewall (32) which joins a substrate capture insert bottom (33)to a substrate capture chamber insert port (34). The substrate capturechamber insert (31) can be removably coupled to the inside of thesubstrate capture chamber (2) to alter the configuration or volume ofthe substrate capture chamber (2). The altered configuration or volumecorresponding to the substrate capture chamber insert (31) canaccordingly increase or decrease the volume of substrate (15) capturedin the substrate capture chamber (2) and accordingly adjust the suturepurchase (30) (as shown in the illustrative example of FIG. 34). Thesubstrate capture chamber insert (31) can have an insert apertureelement (35) disposed to fluidically couple the internal volume of thesubstrate capture chamber insert (31) and substrate capture chamberinsert port (34) with a first longitudinal channel (36) which couplesthe substrate capture chamber (2) to a vacuum port (37) through whichfluid flow (38) passes to regulate the chamber pressure (22) within thesubstrate capture chamber (2). As shown in the illustrative example ofFIG. 12, the substrate capture chamber insert (31) can have a substratecapture chamber insert bottom (33) which between interchangeableembodiments can be disposed at a depth equal to or less than thedistance between the substrate capture chamber bottom (19) and thechamber port (20). The substrate capture chamber insert port (34) canhave an open area about equal to or less than the open area defined bythe chamber port (20). However, this illustrative example is notintended to preclude other configurations of the substrate captureinsert (31) which can alter only the chamber sidewall (18), only thechamber port (20), or only the chamber bottom (19), or combinationsthereof.

Now referring primarily to FIGS. 13 through 16, a thread captureassembly (9) can be disposed in the thread capture chamber (8). Thethread capture assembly (9) can include at least one resilientlyflexible hook member (39A) correspondingly terminating in at least onehook (40A). The resiliently flexible hook member (39A) can be coupled tothe thread capture chamber internal surface (41) to dispose the hook(40A) at a location to engage the thread carrier (3) and flexing the atleast one resiliently flexible hook member (39A). As to particularembodiments, the thread capture assembly (9) can include a pair ofresiliently flexible hook members (39A)(39B) each correspondinglyterminating in one of a pair of hooks (40A)(40B). The pair ofresiliently flexible hook members (39A)(39B) can each be coupled to thethread capture chamber internal surface (41) to dispose the pair ofhooks (40A)(40B) a distance apart at locations which allow correspondingengagement on opposed sides of the thread carrier (3), thereby flexingeach of the pair of resiliently flexible hook members (39A)(39B) (asshown in the example of FIGS. 13 and 14). Upon retraction of the threadcarrier (3) from the thread capture chamber (8), the pair of resilientlyflexible hook members (39A)(39B) each return toward the unflexedcondition correspondingly disengaging each of the pair of hooks(40A)(40B) from the thread carrier (3).

Again, referring primarily to FIGS. 13 through 16, the thread carrier(3) can further include a notch (42) disposed a distance axially fromthe thread carrier aperture element (43). The notch (42) defines a notchpassage (44) between notch passage first and second ends (45)(46) whichopen on the thread carrier external surface (47). The notch (42) can bedisposed angularly across the thread carrier longitudinal axis (48) ofthe thread carrier (3) to dispose the notch passage first end (45)facing away from the chamber port (20) proximal the thread carrierterminal end (7) and the notch passage second end (46) facing toward thechamber port (20) distal from the thread carrier terminal end (7). Thehook (40A) or the pair of hooks (40A)(40B) engage the thread carrier (3)flexing at least one resiliently flexible hook member (39A) or pair ofresiliently flexible hook members (39A)(39B) and aligning one of thepair of hooks (40A)(40B) with the notch passage second end (46).Resilient flexure moves the hook (40A) into the notch passage second end(46). The hook (40A) travels through the notch passage (44) anddisengages the thread carrier (3) by egress from the notch passage firstend (45).

Now referring primarily to FIGS. 17 through 20, the thread carrier (3)can be coupled to the drive member first end (49) and extend axiallyoutward to terminate in a thread carrier terminal end (7). The threadcarrier (3) can comprise a slender rod which can, but need notnecessarily, taper approaching the thread carrier terminal end (7). Thetaper can be sufficient to allow the thread carrier (3) to pass througha particular type of substrate (15), and as to particular embodiments,the thread carrier (3) can taper to a sharp point at the thread carrierterminal end (7) to pass through a substrate (15) comprising animaltissue. A thread carrier aperture element (43) can be disposed adistance axially from said thread carrier terminal end (7). The threadcarrier aperture element (43) defines a thread carrier aperture (50). Asto particular embodiments, the thread carrier aperture (50) can have athread carrier aperture axis (51) disposed generally orthogonal to thethread carrier longitudinal axis (48) and generally orthogonal to theplane (52) longitudinally bisecting the chamber port (20) (as shown inthe cross section of FIG. 18 which longitudinally bisects the chamberport (20) generally orthogonal to the thread carrier aperture axis(51)).

Now referring primarily to FIGS. 1 through 6, embodiments of thesuturing apparatus (1) can include a housing (53). The housing (53) caninclude a handle (54) and a tubular member (11) which outwardly axiallyextends from the handle (54) terminating in the suturing probe (10). Thehandle external surface (55) can, but need not necessarily, beconfigured to be grippingly engaged by the human hand.

Again, referring primarily to FIGS. 17 through 20, the handle (54) canreceive in axial sliding engagement a thread carrier driver (56). Thethread carrier driver (56) can include an elongate drive member (57)having a length disposed between a drive member first end (49) and adrive member second end (58). The elongate drive member (57) movesaxially inside of the handle (54) in response to a drive member actuator(59). As to particular embodiments, a drive member actuator slot (60)can be disposed in the handle (54) and the drive member actuator (59)can be configured to extend through the drive member actuator slot (60)to present a pressible drive member actuator button (61) which uponforcible urging generates corresponding axial movement of the elongatedrive member (57) inside of the handle (54). As to particularembodiments, the thread carrier driver (56) can be operatedbidirectionally to concurrently reciprocally position the thread carrierterminal end (7) between a thread carrier first position (62) whichlocates the thread carrier terminal end (7) inside of a secondlongitudinal channel (63) which opens to the probe external surface (13)outside of the substrate capture chamber (2) and a thread carrier secondposition (64) with the thread carrier terminal end (7) located in thethread capture chamber (8)(as shown in the examples of FIGS. 7 thorough10). The second longitudinal channel (63) can be fluidically discretefrom the first longitudinal channel (36) coupled to the vacuum source(21). Accordingly, the thread carrier (3) disposed and reciprocallymoved in the second longitudinal channel (63) from the first position(62) to the second position (64) outside of the substrate capturechamber (2) does not require a seal engaging the thread carrier (3) tomaintain reduced chamber pressure (22) in the substrate capture chamber(2) generated in the first longitudinal channel (36) fluidically coupledto the vacuum source (21).

Now referring primarily to FIGS. 17 through 19, the housing (53) can beconfigured to provide a vacuum port (37) opening on the handle externalsurface (55) (as shown in the examples of FIGS. 1 through 6 and 17through 19). The vacuum port (37) can be coupled to a vacuum source (21)(as shown in the example of FIGS. 1 and 2). The vacuum source (21) cancomprise any of a variety of conventional vacuum or suction pumps. Thevacuum source (21) can be operated to generate a reduced chamberpressure (22) in the substrate capture chamber (2).

Now referring primarily to FIGS. 21 through 23, the drive member secondend (58) can be coupled to an arrest assembly (65). The arrest assembly(65) can include one or more of an arrest member (66), a prong receiver(67), and a prong (68). The arrest member (66) can have a lengthdisposed between an arrest member first end (69) and an arrest membersecond end (70). The arrest member first end (69) can be coupled to thethread carrier driver (56). The arrest member second end (70) can have ataper extending toward the arrest member second end (70). Disposedbetween the arrest member first and second ends (69)(70) can be a prongreceiver (67). The prong receiver (67) can engage the prong (68) whichcan be coupled to the internal surface (71) of the handle (54). Thethread carrier driver (56) can be operable to concurrently axially movethe thread carrier (3) and the arrest member (66). The arrest member(66) can flex, allowing the prong (68) to disengage the prong receiver(67) when the thread carrier driver (56) operates to move the threadcarrier (3) toward the thread carrier second position (64). The arrestmember (66) can also flex to allow the prong (68) to traverse along thetaper of the arrest member second end (70) toward the prong receiver(67), where the prong (68) can engage the prong receiver (67) when thethread carrier driver (56) operates to move the thread carrier (3)toward the thread carrier first position (62).

Now referring primarily to FIGS. 1 through 11 and 24, a thread (4) canbe disposed in the thread carrier aperture element (43). To assist indisposing the thread (4) in the thread carrier aperture element (43),particular embodiments, can include a thread slot (72). The thread slot(72) can be disposed in the suturing probe (10) adjacent the opening ofthe second longitudinal channel (63) in the suturing probe externalsurface (13). The location of the thread carrier aperture element (43)disposed in the first position (62) can align with the thread slot (72)to permit a thread (4) to be passed through the thread slot (72) and thethread carrier aperture element (43).

Now referring primarily to FIGS. 24 through 28, in particularembodiments, a method in a suturing apparatus (1) can include passing afirst end (73) of a thread (4) through the thread carrier apertureelement (43) disposed on the thread carrier (3). In particularembodiments, the method can further include passing the first end (73)of the thread (4) through the thread carrier aperture element (43) whileit is aligned with the thread slot (72) disposed in the handle (54). Inparticular embodiments, the second end (74) of the thread (4) (or bothends of the thread (4)) can be retained in a thread catch (75) disposedon the handle (54). An embodiment of the thread catch (75) can include athread catch base (76) including a thread catch slot (77) configured tocatch and retain a thread (4). In the embodiment, shown in FIGS. 24through 28, the thread catch (75) can, but need not necessarily include,one or more friction pads (78) disposed in opposed relation about thethread catch slot (77). In particular embodiments, the friction pads(78) can comprise an elastomeric material which increases friction onthe thread (4) when disposed in the thread catch slot (77). Inparticular embodiments, the thread catch (75) can include a thread catchbase (76) including a thread catch aperture element (80). The threadcatch aperture element (80) can define a thread catch aperturecommunicating between a distal end of the thread catch (75) and aproximal end of the thread catch (75). The thread (4) can be passedthrough the thread catch aperture in a distal to proximal direction.

Referring primarily to FIGS. 29 through 32, a method in a suturingapparatus (1) can include driving a thread carrier (3) slidingly engagedto the suturing probe (10) toward the thread capture chamber (8).Slidingly engaging a thread capture assembly (9) disposed in the threadcapture chamber (8) with the thread carrier (3) carrying the thread (4).Disposing the thread (4) adjacent at least one resiliently flexible hookmember (39A) terminating in a hook (40A). Aligning the hook (40A) with anotch second end (46) of the notch (42) disposed in the thread carrier(3) (as shown in the examples of FIGS. 29 and 30). Driving the threadcarrier (3) slidingly engaged to the suturing probe (10) away from thethread capture chamber (8) to move the hook (40A) through the notchpassage (44). Capturing the thread (4) on the hook (40A) (as shown inthe example of FIGS. 31 and 32).

Now referring primarily to FIG. 33A through 33E, a method in a suturingapparatus (1) can include passing a first end (73) of a thread (4)through the thread carrier aperture element (43) disposed on the threadcarrier (3) (as shown in the example of FIG. 33A). Inserting a suturingprobe (10) into a body opening (14) of a substrate (15) (as shown in theexample of FIG. 33B). Forcibly urging the substrate (15) toward asubstrate capture chamber (2) disposed in the suturing probe (10) whichas to particular embodiments, includes contacting the substrate (15)with a finger (24) or other instrument or device (as shown in theexample of FIG. 33C). Capturing the substrate (15) in the substratecapture chamber (2), which can, but need not necessarily, includegenerating a reduced chamber pressure (22) in the substrate capturechamber (2) by operation of a vacuum source (21) to draw and retain anamount of the substrate (15) in the substrate capture chamber (2).Driving a thread carrier (3) slidably engaged in the suturing probe (10)toward a thread capture chamber (8). Passing the thread carrier (3)carrying the thread (4) through the substrate (15) outside of thesubstrate capture chamber (2) into the thread capture chamber (8) (asshown in the example of FIG. 33D). Engaging the thread carrier (3) witha thread capture assembly (9) disposed in the thread capture chamber(8). Capturing the thread (4) on the thread capture assembly (9).Reciprocally driving a thread carrier (3) from the thread capturechamber (8) and through the substrate (15) to generate a thread loop inthe substrate (15) (as shown in the example of FIG. 33E). In particularembodiments, the methods can further include inserting a substratecapture chamber insert (31) into the substrate capture chamber (2).

With regards to driving a thread carrier (3) in the suturing probe (10)toward a thread capture chamber (8), the method can further includepressing a drive member actuator button (61) extending through the drivemember actuator slot (60) in a handle (54) of the suturing apparatus(1). The pressing can generate movement in the thread carrier (3) in afirst direction (79) toward the thread capture chamber (8). The movementof the thread carrier (3) in a first direction (79) can pass the threadcarrier (3) through the substrate (15) outside of the substrate capturechamber (2) into the thread capture chamber (8) without compromising theintegrity of the reduced chamber pressure (22) generated by a vacuumsource (21) fluidically coupled to the substrate capture chamber (2). Inparticular embodiments, the method can further include flexing an arrestassembly (65), thereby disengaging the prong (68) from the prongreceiver (67) and advancing the prong (68) along the taper of the arrestmember second end (70) and to permit the movement of the thread carrier(3) in the first direction (79).

Now referring primarily to FIG. 34, there can be an advantage in varyingthe configuration or volume of the substrate capture chamber (2).Various configurations and volumes of the substrate capture chamber (2)can by utilizing a substrate capture chamber insert (31) and the optionof utilizing a vacuum source (21) to reduce pressure (22) in thesubstrate capture chamber (2) correspondingly vary, the suture purchase(30) in the substrate (15, 16) depending on the requirements of theapplication. In particular embodiments which include a vacuum source(21), reducing pressure (22) in the substrate capture chamber (2) cancapture an increased amount of substrate (15) in the substrate capturechamber (2), thereby increasing the suture purchase (30). The suturepurchase (30) can be adjusted by the use of a substrate capture chamberinsert (31) which varies the volume of the substrate capture chamber (2)available to receive the substrate (15). In other particularembodiments, a substrate capture chamber insert (31) can be utilizedwithout a vacuum source (21), decreasing the suture purchase (30) asopposed to an application which utilizes a vacuum source (21). Thus, byaltering the factors of utilizing a substrate capture chamber insert(31) and the utilization of a vacuum source (21), the suture purchase(30) can be increased or decreased depending upon the application.

As can be easily understood from the foregoing, the basic concepts ofthe present invention may be embodied in a variety of ways. Theinvention involves numerous and varied embodiments of a mountablecarrier and methods for making and using such mountable carrierincluding the best mode.

As such, the particular embodiments or elements of the inventiondisclosed by the description or shown in the figures or tablesaccompanying this application are not intended to be limiting, butrather exemplary of the numerous and varied embodiments genericallyencompassed by the invention or equivalents encompassed with respect toany particular element thereof. In addition, the specific description ofa single embodiment or element of the invention may not explicitlydescribe all embodiments or elements possible; many alternatives areimplicitly disclosed by the description and figures.

It should be understood that each element of an apparatus or each stepof a method may be described by an apparatus term or method term. Suchterms can be substituted where desired to make explicit the implicitlybroad coverage to which this invention is entitled. As but one example,it should be understood that all steps of a method may be disclosed asan action, a means for taking that action, or as an element which causesthat action. Similarly, each element of an apparatus may be disclosed asthe physical element or the action which that physical elementfacilitates. As but one example, the disclosure of a “mount” should beunderstood to encompass disclosure of the act of “mounting”—whetherexplicitly discussed or not—and, conversely, were there effectivelydisclosure of the act of “mounting”, such a disclosure should beunderstood to encompass disclosure of a “mount” and even a “means formounting.” Such alternative terms for each element or step are to beunderstood to be explicitly included in the description.

In addition, as to each term used it should be understood that unlessits utilization in this application is inconsistent with suchinterpretation, common dictionary definitions should be understood to beincluded in the description for each term as contained in the RandomHouse Webster's Unabridged Dictionary, second edition, each definitionhereby incorporated by reference.

All numeric values herein are assumed to be modified by the term“about”, whether or not explicitly indicated. For the purposes of thepresent invention, ranges may be expressed as from “about” oneparticular value to “about” another particular value. When such a rangeis expressed, another embodiment includes from the one particular valueto the other particular value. The recitation of numerical ranges byendpoints includes all the numeric values subsumed within that range. Anumerical range of one to five includes for example the numeric values1, 1.5, 2, 2.75, 3, 3.80, 4, 5, and so forth. It will be furtherunderstood that the endpoints of each of the ranges are significant bothin relation to the other endpoint, and independently of the otherendpoint. When a value is expressed as an approximation by use of theantecedent “about,” it will be understood that the particular valueforms another embodiment. The term “about” generally refers to a rangeof numeric values that one of skill in the art would consider equivalentto the recited numeric value or having the same function or result.Similarly, the antecedent “substantially” means largely, but not wholly,the same form, manner or degree and the particular element will have arange of configurations as a person of ordinary skill in the art wouldconsider as having the same function or result. When a particularelement is expressed as an approximation by use of the antecedent“substantially,” it will be understood that the particular element formsanother embodiment.

Moreover, for the purposes of the present invention, the term “a” or“an” entity refers to one or more of that entity unless otherwiselimited. As such, the terms “a” or “an”, “one or more” and “at leastone” can be used interchangeably herein.

Thus, the applicant(s) should be understood to claim at least: i) eachof the mountable carriers herein disclosed and described, ii) therelated methods disclosed and described, iii) similar, equivalent, andeven implicit variations of each of these devices and methods, iv) thosealternative embodiments which accomplish each of the functions shown,disclosed, or described, v) those alternative designs and methods whichaccomplish each of the functions shown as are implicit to accomplishthat which is disclosed and described, vi) each feature, component, andstep shown as separate and independent inventions, vii) the applicationsenhanced by the various systems or components disclosed, viii) theresulting products produced by such systems or components, ix) methodsand apparatuses substantially as described hereinbefore and withreference to any of the accompanying examples, x) the variouscombinations and permutations of each of the previous elementsdisclosed.

The background section of this patent application provides a statementof the field of endeavor to which the invention pertains. This sectionmay also incorporate or contain paraphrasing of certain United Statespatents, patent applications, publications, or subject matter of theclaimed invention useful in relating information, problems, or concernsabout the state of technology to which the invention is drawn toward. Itis not intended that any United States patent, patent application,publication, statement or other information cited or incorporated hereinbe interpreted, construed or deemed to be admitted as prior art withrespect to the invention.

The claims set forth in this specification, if any, are herebyincorporated by reference as part of this description of the invention,and the applicant expressly reserves the right to use all of or aportion of such incorporated content of such claims as additionaldescription to support any of or all of the claims or any element orcomponent thereof, and the applicant further expressly reserves theright to move any portion of or all of the incorporated content of suchclaims or any element or component thereof from the description into theclaims or vice-versa as necessary to define the matter for whichprotection is sought by this application or by any subsequentapplication or continuation, division, or continuation-in-partapplication thereof, or to obtain any benefit of, reduction in feespursuant to, or to comply with the patent laws, rules, or regulations ofany country or treaty, and such content incorporated by reference shallsurvive during the entire pendency of this application including anysubsequent continuation, division, or continuation-in-part applicationthereof or any reissue or extension thereon.

Additionally, the claims set forth in this specification, if any, arefurther intended to describe the metes and bounds of a limited number ofthe preferred embodiments of the invention and are not to be construedas the broadest embodiment of the invention or a complete listing ofembodiments of the invention that may be claimed. The applicant does notwaive any right to develop further claims based upon the description setforth above as a part of any continuation, division, orcontinuation-in-part, or similar application.

The invention claimed is:
 1. An apparatus, comprising: a suturing probeincluding a suturing probe recessed external surface delimiting an openarea; a thread capture chamber opening into said open area; a substratecapture chamber, said substrate capture chamber opens into said openarea; a chamber port includes a continuous transition edge whichdelimits an entry into said substrate capture chamber, said chamber portopen to said suturing probe recessed external surface; said transitionedge circumscribing an area less than an area circumscribed by aperipheral margin which delimits an entry into said open area; and athread carrier slidingly engaged to said suturing probe, said threadcarrier passes outside said substrate capture chamber into said threadcapture chamber.
 2. The apparatus of claim 1, wherein said threadcarrier passing within said suturing probe recessed external surfaceoutside of said substrate capture chamber port.
 3. The apparatus ofclaim 2, further comprising a thread carrier aperture element disposedproximate a thread carrier terminal end, said thread carrier apertureelement defining a thread carrier aperture communicating between opposedaperture openings on a thread carrier external surface.
 4. The apparatusof claim 3, further comprising a thread slot disposed in a suturingprobe external surface, said thread carrier aperture alignable with saidthread slot to pass a thread through said thread carrier aperture. 5.The apparatus of claim 4, wherein said thread carrier aperture having anaperture axis disposed generally orthogonal to a longitudinal axis ofsaid thread carrier.
 6. The apparatus of claim 4, wherein said substratecapture chamber includes a chamber sidewall which couples in opposedfixed relation to a chamber bottom a distance from said chamber port. 7.The apparatus of claim 6, further comprising a substrate capture chamberinsert removably coupled inside of said substrate capture chamber, saidsubstrate capture chamber insert having substrate capture chamber insertbottom disposable at a depth less than the distance between said chamberbottom and said chamber port.
 8. The apparatus of claim 7, wherein saidsubstrate capture chamber insert removably coupled inside of saidsubstrate capture chamber defines a substrate capture chamber insertport open to said external surface of said suture probe, said substratecapture chamber insert port having an open area equal to or less than anopen area defined by said chamber port.
 9. An apparatus, comprising: asuturing probe including a thread capture chamber disposed adjacent asubstrate capture chamber, said substrate capture chamber having achamber open to a suturing probe external surface; and a thread carrierslidingly engaged to said suturing probe, said thread carrier passesoutside said substrate capture chamber into said thread capture chamber;a substrate capture chamber insert removably coupled inside of saidsubstrate capture chamber, said substrate capture chamber insert havinga substrate capture chamber insert bottom disposable at a depth lessthan the distance between a chamber bottom and a chamber port; whereinsaid substrate capture chamber insert defines a substrate capturechamber insert entry open to said external surface of said suture probe,a substrate capture chamber insert port having an open area less than anopen area defined by said chamber port; and wherein said chamber insertentry has a stadium configuration.
 10. The apparatus of claim 9, whereinsaid substrate capture chamber insert bottom and said substrate capturechamber insert port each having a stadium configuration.
 11. Theapparatus of claim 9, wherein said thread carrier includes a notchdisposed in said thread carrier external surface, said notch defining anotch passage between notch passage first and second ends open on saidthread carrier external surface, said notch disposed angularly across alongitudinal axis of said thread carrier to dispose said notch passagefirst end proximate said thread carrier terminal end and to dispose saidnotch passage second end distal said thread carrier terminal end. 12.The apparatus of claim 11, further comprising a thread capture assemblydisposed within said thread capture chamber, said thread captureassembly including at least one resiliently flexible hook memberterminating in a hook, said hook disposed in said thread capture chamberengages said thread carrier flexing said at least one resilientlyflexible hook member, said hook aligned with said notch second end movesinto said notch passage, said hook disengaging said thread carrier byegress from said notch first end.
 13. The apparatus of claim 12, whereinsaid hook disengaging said thread carrier by egress from said notchfirst end captures said thread to retain a thread loop.
 14. Theapparatus of claim 13, wherein said thread capture assembly includes apair of resiliently flexible hook members correspondingly terminating inone of a pair of hooks, said pair of hooks disposed in said threadcapture chamber to engage said thread carrier flexing said pair ofresiliently flexible hook members, wherein one of said pair of hooksaligned with said notch second end moves into said notch passage, saidhook disengaging said thread carrier by egress from said notch firstend.
 15. The apparatus of claim 14, further comprising a tubular memberhaving a length disposed between a tubular member first end and atubular member second end, said tubular member first end coupled to saidsuturing probe, said tubular member second end coupled to a handle. 16.The apparatus of claim 15, further comprising a thread catch disposed onsaid handle adjacent said tubular member, said thread catch configuredto releasably retain said thread.
 17. The apparatus of claim 16, furthercomprising a thread carrier driver coupled to said thread carrieropposite said thread carrier terminal end, said thread carrierresponsive to said thread carrier driver to pass outside of saidsubstrate capture chamber into said thread capture chamber.
 18. Theapparatus of claim 17, further comprising a thread carrier driveractuator extending through a drive member actuator slot in said handleto provide a pressible drive member actuator button.
 19. The apparatusof claim 18, further comprising an arrest assembly coupled to saidthread carrier driver, said arrest assembly including: an arrest memberhaving a length disposed between an arrest member first end coupled tosaid thread carrier driver and an arrest member second end having ataper extending toward said arrest member second end; a prong receiverdisposed between said arrest member first and second ends; a prongcoupled to an internal surface of said handle, said prong engageablewith said prong receiver; said thread carrier driver operable toconcurrently axially move said thread carrier and said arrest member,said arrest member flexes to allow said prong to disengage said prongreceiver, said prong traversing along said taper of said arrest membersecond end, thereby disposing said thread carrier in a first threadcarrier position inside of said thread capture chamber.
 20. Theapparatus of claim 19, wherein said arrest member flexes to allow saidprong to traverse along said taper of said arrest member second endtoward said prong receiver, said prong engaging said prong receiver todispose in a second thread carrier position outside of said threadcapture chamber.
 21. The apparatus of claim 20, further comprising avacuum source coupled to said substrate capture chamber.
 22. Theapparatus of claim 21, further comprising a discrete first longitudinalchannel coupled between said vacuum source and said substrate capturechamber; and a discrete second longitudinal channel disposed in saidtubular member capable of permitting said thread carrier to reciprocallyaxially move, said second longitudinal channel being devoid of a seal.